Wisconsin Physicians Service Insurance Corporation Did Not Properly Settle Missouri Medicare Disproportionate Share Hospital Payments 

With respect to Medicaid patient days, Wisconsin Physicians Service Insurance Corporation (WPS) did not properly settle for Federal fiscal years (FYs) 2010 through 2012 Medicare cost reports submitted by inpatient hospitals in Missouri (Missouri providers) for Medicare disproportionate share hospital (DSH) payments in accordance with Federal requirements. The 20 settled Medicare cost reports that Missouri providers submitted for FYs 2010 through 2012 reflected 612,517 Medicaid patient days. The 10 selected providers (with those 20 associated cost reports) improperly claimed a total of 7,132 Medicaid patient days on their cost reports, resulting in DSH overpayments totaling $3.0 million. These improper claims included both unallowable and unsupported Medicaid patient days and involved patients in the excluded categories of family planning and family planning-related services, the Children's Health Insurance Program, temporary prenatal care services, State-only programs, patients who did not meet the designated spenddown requirements to qualify for spenddown programs, and dual eligibility.